The Center for Excellence in Chronic Illness Care has developed, tested, and disseminated a program of disease management for vulnerable patients with nonmalignant chronic pain. The program utilizes a customized patient registry, evidence-based treatment algorithms, and use of a multidisciplinary team approach to care anchored by physician extenders that include a clinical pharmacist practitioner, a physician assistant, a nurse clinician, and a care assistant.

The General Medicine Pain Service (GMPS) manages over 200 patients with nonmalignant chronic pain. These patients require direct referral to the GMPS by providers in the UNC Internal Medicine Clinic. Goals of the program include reducing a patient’s day-to-day pain, improving a patient’s ability to participate in activities of daily living, and addressing overlaying symptoms such as sleep and/or mood disorders. The GMPS works to achieve these goals through pharmacological management as well as outside referral for non-medication based rehabilitation such as physical or aquatic therapy, surgical or procedural intervention, and cognitive-behavioral therapy. The GMPS also focuses on disease prevention by encouraging self-care through exercise, improvement in diet, smoking cessation, and enrollment in other disease management programs, including diabetes management and/or anticoagulation care.